Senior Analyst, SIU Investigator

This is a fully remote position, open to applicants in Arizona, +2 more states.

📋 Description

• Proactively identify and investigate instances of known or suspected fraud, waste, and abuse (FWA) with a high degree of independence.

• Create comprehensive documentation to support findings, including formal reports, visual data representations, audit logs, and other relevant materials.

• Achieve objectives through investigative efforts and internal enhancements aimed at recovering FWA losses and generating savings.

• Analyze previous cases to aid in the future identification of similar claims or cases and their associated savings.

• Assist in transitioning from a reactive “pay-and-chase” approach to proactive edits and prepayment measures.

• Engage in the creation and delivery of FWA-related training for Oscar teams.

• Adhere to all relevant laws and regulations.

• Execute additional responsibilities as assigned.

• Report directly to the Investigations Manager, SIU.

⛳️ Requirements

• A minimum of 3 years of experience in insurance claims investigation or professional investigative work with law enforcement entities.

• At least 1 year of experience with relevant fraud laws and regulations, as well as federal guidelines pertaining to recoupments and other anti-FWA initiatives.

• Must be authorized to work in the United States on a full-time basis.

• A Bachelor's degree in Criminal Justice or a related field is preferred (bonus point).

• Experience in health insurance across multiple product lines, particularly in claims processing, billing, reimbursement, or provider contracting is a plus (bonus point).

• Familiarity with HIPAA, data privacy, and data security protocols is advantageous (bonus point).

• Possession of certifications such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or similar is a bonus (bonus point).

• Certified Professional Coder (CPC) or equivalent certification is a bonus (bonus point).

🏝️ Benefits

• Comprehensive employee benefits.

• An unlimited vacation policy.

• Annual performance-based bonuses.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• 11 paid holidays.

• Paid sick leave.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life insurance coverage.

• Disability insurance.

• Paid wellness time.

• Reimbursements for wellness activities.